Rheumatoid arthritis （RA） is a common chronic systemic autoimmune disease with synovitis as the main manifestation， which often causes joint swelling and pain or even deformity. It is considered to be an incurable lifelong disease. Although the current Western medicine treatment can alleviate the progression of the disease， it has the clinical limitations of liver injury， cardiovascular complications， and other adverse reactions， along with easy recurrence. Traditional Chinese medicine （TCM） has a long history and has the advantages of individualized treatment and fewer adverse reactions. It can effectively relieve the symptoms of joint swelling and pain in RA patients and slow down the progression of bone destruction， which has attracted wide concern in the medical community. Janus kinase （JAK）/signal transducer and activator of transcription （STAT） signaling pathway is an important intracellular pathway involved in cell proliferation， differentiation， apoptosis， immune regulation， and other biological behaviors， and plays an important role in the pathophysiological process of RA. In recent years， many studies have confirmed that TCM monomers and compounds can inhibit inflammation and angiogenesis by regulating the JAK/STAT signaling pathway， induce apoptosis and inhibit proliferation of fibroblast-like synoviocytes （FLS）， regulate immune response， and thus exert an effect in the treatment of RA. However， there is still a lack of comprehensive and systematic induction and overview. Therefore， by searching the relevant literature in China National Knowledge Infrastructure （CNKI） and PubMed databases from 2009 to 2024， this study described the mechanism of the JAK/STAT signaling pathway in the occurrence and development of RA and summarized the research progress of TCM monomers and compounds in regulating the JAK/STAT signaling pathway in RA intervention. The study aims to provide new ideas and strategies for the clinical treatment of RA with TCM and the research and development of new drugs.

Standardized reporting is a crucial factor affecting the use of patient guidelines （PGs）， particularly in the reporting and presentation of recommendations. This paper introduced the current status of PG reporting， including the research on PG content and presentation formats， and provided comprehensive recommendations for PG reporting from aspects such as overall framework， recommendations， presentation format， and readability. First， the presentation of PG recommendations should include clearly defined clinical questions， recommendations and their rationale， and guidance on how patients should implement the interventions； for specific content in the PG， such as level of evidence， level of recommendation， it is recommended to explain in text the reasons for giving different levels of recommendation， i.e.， to present the logic behind giving the level of recommendation to the patient； additional information needed in the recommendation framework should be supplemented by tracing references or authoritative textbooks and literature that support the recommendations. Subsequently， the PG text should be written based on the Reporting Checklist for Public Versions of Guidelines （RIGHT-PVG） reporting framework. Finally， to enhance readability and comprehension， it is recommended to refer to the Patient Education Materials Assessment Tool （PEMAT） for translating PG content. To enhance the readability of PGs， it is suggested to present the PG content in a persona-lized and layered manner.

Since the concept of patient versions of guidelines （PVGs） was introduced into China， several PVGs have been published in China， but we found that there is a big difference between the concept of PVG at home and abroad， and the reason for this difference has not been reasonably explained， which has led to ambiguity and even misapplication of the PVG concept by guideline developers. By analyzing the background and purpose of PVGs， and the understanding of the PVG concept by domestic scholars， we proposed the term patient guidelines （PGs）. This refers to guidelines developed under the principles of evidence-based medicine， centered on health issues that concern patients， and based on the best available evidence， intended for patient use. Except for the general attribute of providing information or education， which is typical of common health education materials， PGs also provide recommendations and assist in decision-making， so PGs include both the patient versions of guidelines （PVG） as defined by the Guidelines International Network （GIN） and "patient-directed guidelines"， i.e. clinical practice guidelines resulting from the adaptation or reformulation of recommendations through clinical practice guidelines.

At present， the process and methodology of patient guidelines （PGs） development varies greatly and lacks systematic and standardised guidance. In addition to the interviews with PG developers， we have sorted out the relevant methodology for the adaptation and development of existing clinical practice guideline recommendations and facilitated expert deliberations to achieve a consensus， so as to finally put forward a proposal for guidance on the process and methodology for the development of PGs. The development of PGs can be divided into the preparation stage， the construction stage， and the completion stage in general， but the specific steps vary according to the different modes of development of PGs. The development process of Model 1 is basically the same as the patient version of the guideline development process provided by the International Guidelines Network， i.e.， team formation， screening of recommendations， guideline drafing， user testing and feedback， approval and dissemination. The developer should also first determine the need for and scope of translating the clinical practice guideline into a patient version during the preparation phase. Model 2 adds user experience and feedback to the conventional clinical practice guideline development process （forming a team， determining the scope of the PG， searching， evaluating and integrating evidence， forming recommendations， writing the guideline， and expert review）. Based on the different models， we sort out the process and methods of PG development and introduce the specific methods of PG development， including how to identify the clinical problem and how to form recommendations based on the existing clinical practice guidelines， with a view to providing reference for guideline developers and related researchers.

Objective:To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness (ICU-AW) patients using evidence-based methods, providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients.Methods:A systematic search was conducted on the American Thoracic Society (ATS) Clinical Practice Guidelines, Registered Nurses' Association of Ontario (RNAO), Guidelines International Network (GIN), Canadian Medical Association Clinical Practice Guideline Library (CMACPGL), BMJ Clinical Evidence, UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), PubMed, Cochrane Library, National Guideline Clearinghouse (NGC), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), UM-library, Physiotherapy Evidence Database (PEDro), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Chinese Medical Pulse Guidelines Website, CNKI and Wanfang data and other Chinese and English databases, professional team websites, and guideline websites for expert consensus, guidelines, randomized collected trial (RCT), systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients. The search time limit was from the establishment of the database to December 31, 2023. Literature search, screening, evaluation, information extraction was independently conducted by two evaluators with cross checking, and quality evaluation of the included literature was conducted.Results:A total of 21 literatures were enrolled, including 5 guidelines, 5 systematic reviews, 4 expert consensuses, and 7 RCT, all of which with high evidence level and all were enrolled. They were summarized into seven aspects with assessment screening, exercise safety standards, precautions, setting of exercise time, exercise intensity, exercise sequence, and recommended exercise content as the core, and 32 best evidences.Conclusions:The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients. ICU medical practitioners need to combine the actual clinical environment, individual differences and rehabilitation goals of patients, to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.

Objective To explore the effects of Zengye Runzao Decoction on mRNAs and proteins related to submandibular gland tissue and the expression of Th17/Treg in peripheral blood of Sj?gren syndrome(SS)model mice.Methods SPF Balb/c mice were randomly divided into control group and modeling group,the modeling group established an SS mouse model through immune induction,while the control group was not treated.The modeled mice were randomly divided into model group,total glucosides of Paeoniae Radix Alba group and Zengye Runzao Decoction low-,medium-and high-dosage groups,with 3 mice in each group.The total glucosides of Paeoniae Radix Alba group was given 0.234 mg/g total glucosides of Paeoniae Radix Alba solution by gavage,Zengye Runzao Decoction low-,medium-and high-dosage groups were given 4,8,12 mg/g Zengye Runzao Decoction by gavage,and the control group and model group were given the same volume of distilled water by gavage,once a day for 60 consecutive days.The daily water intake,salivary flow rate and submandibular index were calculated,the tissue morphology of submandibular gland was observed by HE staining,the expressions of HOXA1,STAT3,IL-17,FOXP3 mRNA and miR-181c-3p in submandibular gland tissue were detected by qPCR,Western blot was used to detect the expressions of HOXA1,STAT3,p-STAT3,IL-17 and FOXP3 protein in submandibular gland tissue,the proportion of Th17 and Treg cells in peripheral blood was detected by flow cytometer.Results Compared with the control group,the daily water intake of the model group mice increased,saliva flow rate and submandibular gland index decreased,lymphocyte infiltration in submandibular gland tissue was significant,the expressions of HOXA1,STAT3,IL-17 mRNA increased,the expressions of FOXP3 mRNA and miR-181c-3p decreased,the expressions of HOXA1,STAT3,p-STAT3,IL-17 protein increased,FOXP3 protein expression decreased,Th17 ratio and Th17/Treg increased,and Treg ratio decreased,with statistical significance(P<0.05).Compared with the model group,the daily water intake of Zengye Runzao Decoction groups decreased,the saliva flow rate increased,and the infiltration of lymphocytes in the submandibular gland tissue was reduced to varying degrees,the expressions of HOXA1 and IL-17 mRNA decreased,while the expressions of FOXP3 mRNA and miR-181c-3p increased,the expression of HOXA1 protein decreased,while the expression of FOXP3 protein increased,the ratio of Th17 and Th17/Treg decreased,and the Treg ratio increased.The submandibular gland index increased in Zengye Runzao Decoction high-dosage group,and the expressions of STAT3 mRNA and protein,as well as p-STAT3 and IL-17 protein decreased,with statistical significance(P<0.05).Conclusion Zengye Runzao Decoction may regulate Th17/Treg cell imbalance by up-regulating the expressions of miR-181c-3p,FOXP3 and down-regulating the expressions of HOXA1,p-STAT3,STAT3 and IL-17,and then improve the function and tissue injury of submandibular gland caused by SS.

Objective:To explore the application of endoscopic narrow-band imaging(NBI) in the early diagnosis of throat malignant tumors.Methods:From January 2014 to December 2019, 512 patients with suspected benign or malignant diseases of the throat in the First People's Hospital of Wenling were selected, and all patients were performed white light endoscopy and NBI endoscopy.The biopsies were taken for pathological examination.The histopathological results were seemed as gold standard for diagnosis.Results:NBI endoscopy was superior to white light endoscope in terms of microvascular morphology and lesion outline(χ 2=457.497, 293.209, all P<0.05). The diagnostic coincidence rate, sensitivity and negative coincidence rate of NBI endoscope for malignant tumors were higher than those of white light endoscope(χ 2=10.131, 6.197, 4.084, all P<0.05). The sensitivity of NBI endoscope type Ⅰ-Ⅱ in the diagnosis of benign lesions was 90.65%, and the specificity was 96.88%.The sensitivity and specificity of NBI endoscope type Ⅲ-Ⅳ in the diagnosis of mild-moderate dysplasia were 80.99% and 97.52%, respectively.The sensitivity and specificity of NBI endoscopy type Va in the diagnosis of severe atypical hyperplasia were 15.18% and 98.54%, respectively.The sensitivity and specificity of NBI endoscope Va-c in the diagnosis of invasive cancer were 93.24% and 96.93%, respectively. Conclusion:Compared with white light endoscope, NBI endoscope can more clearly show the outline of lesions and submucosal blood vessels, and can more accurately diagnose malignant tumors in the throat, especially can more recognized the pre-cancerous lesions and early malignant tumors.It has important clinical application value in early diagnosis of malignant tumor in the throat.

Objective:To investigate the effect of pulmonary vascular dysfunction in the prognosis of patients with acute lung injury (ALI).Methods:Patients with ALI who underwent pulmonary artery catheterization in the department of critical care medicine of Wuhan NO.1 Hospital from June 2017 to June 2019 were enrolled. The general information, clinical and hemodynamic indexes [central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), pulmonary artery systolic pressure (sPAP), pulmonary artery diastolic pressure (dPAP), mean pulmonary artery pressure (mPAP), cardiac index (CI)], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, arterial blood gas parameters [pH, partial pressure of oxygen (PO 2), partial pressure of carbon dioxide (PCO 2), oxygenation index (PaO 2/FiO 2)], whether there was shock or not; ventilator parameters [platform pressure (Plat), positive end-expiratory pressure (PEEP)], etc. were recorded. Pulmonary artery oxygen saturation, pulmonary vascular function indexes [transpulmonary potential gradient (TPG) and pulmonary vascular resistance index (PVRi)] were calculated. The relationship between TPG, PVRi and mechanical ventilation time, the length of intensive care unit (ICU) stay, cardiovascular days and 60-day mortality were analyzed in patients with different prognosis of 60-day and whether the TPG increased (≥12 mmHg was defined as elevated TPG, 1 mmHg = 0.133 kPa). Results:A total of 65 patients were included in the study, including 30 males and 35 females; aged (48.9±15.2) years old. Forty-eight cases survived in 60-days, 17 died, and the 60-day mortality was 26.2%. At the baseline, there were no significant differences in cardiopulmonary function measurements, such as CVP, sPAP, dPAP, PAWP, CI, etc. between the two groups of patients with different prognosis. The APACHEⅡ score, shock ratio, TPG and PVRi of the death group were significant higher than those of the survival group [APACHEⅡ: 34±9 vs. 28±11, shock: 52.9% vs. 25.0%, TPG (mmHg): 16.2±1.9 vs. 14.6±2.1, PVRi (kPa·s·L -1): 31.8±4.2 vs. 29.7±3.5, all P < 0.05]. The 60-day mortality of 47 patients with TPG ≥ 12 mmHg was significantly higher than that of 18 patients with TPG < 12 mmHg (34.0% vs. 5.6%), and the mechanical ventilation time and the length of ICU stay were also significantly longer (days: 17±9 vs. 11±8, 16±5 vs. 12±5), and the cardiovascular days also increased significantly (days: 23±7 vs. 18±6), and the differences were statistically significant (all P < 0.05). Pearson correlation analysis showed that PVRi was significantly correlated with mechanical ventilation time, the length of ICU stay and cardiovascular days ( r1 = 0.317, P1 = 0.030; r2 = 0.277, P2 = 0.005; r3 = 0.285, P3 = 0.002). In the individual multivariate Logistic regression model, the highest PVRi was an independent risk factor for the 60-day mortality [odds ratio ( OR) = 30.5, 95% confidence interval was 20.4-43.1, P = 0.023]. Conclusion:Pulmonary vascular dysfunction is common in ALI patients and is independently associated with adverse outcomes.

Objective To explore the factors affecting methylphenidate (MHP)efficacy in children with attention deficit hyperactivity disorder (ADHD). Methods One hunadard eleven DSM-Ⅳ defined ADHD patients were enrolled for 6 weeks systemic MHP titration treatmnet. ADHD Rating Scale-Ⅳ Home Version (ADHD-RS-Ⅳ) were applied as index of clinical efficacy, and Continuous Performance Task (CPT) as index of cognition efficacy. Determining potential influential factors was analyzed on MPH efficacy including demographic,baseline clinical symptoms and cognitive factors. Results Sixty-five (59.1%) were defined as responders and 45 (40.9%) as non-reponders to MHP, respectively. CPT which were conducted in 87 patient showed that 35 (40.2%) were defined as responders on commission errors, 31 (35.6%) on omission errors and 10 (11.5%) on reaction time. Logistic analysis revealed two potential influential factors that predicted better clinical efficacy (P<0.05): better parental relationship (OR=3.516, 95% CI: 1.087~11.375) and baseline ADHD-RS-Ⅳ score above 35 points (OR=3.075, 95%CI: 1.131~8.359). Higher IQ score was the potential influential factor that predicted better commission errors efficacy (OR=1.085, 95%CI: 1.013~1.162) and omission errors efficacy (OR=1.078, 95%CI: 1.008~1.153). Conclusion MHP efficacy may result in better outcomes in children with ADHD who have higher baseline ADHD-RS-Ⅳ score, poorer baseline CPT result, younger onset age, higher IQ and better parental relationship.

Objective To observe the anti-inflammatory effect and opportunity of continuous blood purification (CBP) for treatment of patients with severe acute pancreatitis (SAP). Methods A retrospective study was conducted. One hundred and sixty patients with SAP admitted into the Department of Critical Care Medicine of the First Hospital of Wuhan from May 2013 to February 2017 were enrolled, and they were treated after admission by continuous vein-venous hemofiltration (CVVH) with blood flow volume 150-200 mL/min, displacement fluid velocity 2000-3500 mL/h and maintenance of ultrafiltration rate 35 mL·kg-1·h-1. According to the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) scores in 24 hours after admission, the patients were divided into four groups: 15-19 scores (group A), 20-24 scores (group B), 25-29 scores (group C), ≥ 30 scores (group D), 40 cases in each group. Before and after treatment for 72 hours, the difference of serum adiponectin, endotoxin, tumor necrosis factor-α (TNF-α), interleukin (IL-6, IL-8) were compared, the changes of APACHE Ⅱ score, multiple organ dysfunction syndrome (MODS) score, systemic inflammatory response syndrome (SIRS) score, and also complications and mortality in 14 days after treatment were observed for the patients. Results Compared with those before CVVH treatment, the levels of endotoxin, TNF-α, IL-6, IL-8 were significantly decreased, adiponectin was significantly increased among the various APACHEⅡ score groups after CVVH treatment, and the changes of various index amplitude variations in groups B and C were more obvious [endotoxin (EU/L): 2.9±1.0 vs. 3.6±1.5, 3.1±1.2 vs. 3.8±1.4; TNF-α (μg/L): 100.5±15.3 vs. 177.5±24.6, 113.7±17.2 vs. 190.4±25.8; IL-6 (μg/L): 107.3±13.5 vs. 230.5±32.4, 118.2±16.1 vs. 244.6±30.2;IL-8 (μg/L): 201.5±25.7 vs. 355.6±47.2, 215.4±29.4 vs. 376.4±47.3; adiponectin (mg/L): 21.9±3.6 vs. 17.6±3.4, 20.8±3.7 vs. 15.8±2.9, all P < 0.05]. Compared with those before treatment, the scores of APACHEⅡ, MODS and SIRS in groups A, B and C were significantly decreased after treatment, among which the changes of the index amplitude variation of group B and group C were more significant (APACHEⅡ: 16.2±1.4 vs. 22.9±1.7, 18.2±1.4 vs. 28.3±2.1; MODS score: 4.4±1.5 vs. 7.7±1.5, all P < 0.05), the scores of APACHE Ⅱ and SIRS in group D were not significantly decreased, but on the contrary the MODS score had an increasing tendency. After treatment, the 14-day mortality was 0%, 0%, 12.5%, 47.5% in group A, B, C, D respectively (χ2 = 8.350, P = 0.039 ), and the incidence of complications was 32.5%, 52.5%, 60.0%, 80.0% after CVVH in group A, B, C, D respectively(χ2 = 27.04, P = 0.028). Conclusion Early CBP treatment can decrease the inflammatory reaction of SAP patients, and the CBP therapeutic effect is relatively good if it is carried out for SAP patients with 20 ≤ APACHE Ⅱ score < 30.